belly pain

When pizza causes pain: does your body hate gluten or lactose?

You just had to have two slices of pepperoni pizza for lunch. After all, work has been a nightmare, and surely you deserved a treat. An hour later, however, you had bigger problems than your boss. You felt a sudden wave of abdominal pain and nausea, which sent you rushing to the bathroom. Was it the cheese?  The bread? The pepperoni? Should you just pop an antacid? Or totally change your diet?

Was it the crust?

Gluten is a protein found in wheat, rye, barley, and beer.  When people with celiac disease eat gluten, their immune system becomes confused and attacks the lining of the intestines. The resulting symptoms include abdominal pain and diarrhea (because the damaged guts can’t digest or absorb food).

Awareness of Celiac disease has greatly increased in recent years. The condition, however, still affects less than 1% of the population. Although some people do have non-celiac gluten sensitivity, many more people avoid gluten than is necessary. Indeed, if you don’t have Celiac disease or gluten intolerance, a gluten-free diet may actually be harmful.

See your doctor for a proper evaluation before you decide to go gluten-free. (Indeed, going gluten-free before the diagnosis is confirmed can interfere with the standard medical evaluation.)

Or the cheese?

Lactose is a type of sugar found in dairy products, like milk, cheese, ice cream, and yogurt. People with lactose intolerance cannot fully digest lactose because they lack an enzyme called lactase. (Note that the sugar is spelled lactOse, while the enzyme is spelled lactAse.) The mostly-unprocessed lactose reaches the bacteria in your intestines, which produce lot of gas as they feast on it. As a result, you experience abdominal pain and bloating.

Lactose intolerance is extremely common, particularly among blacks, Asians, and Hispanics. The main symptoms are abdominal pain, bloating, and diarrhea.  The easiest solution is to avoid (or even just cut back on) milk products. Some dairy products, like Lactaid, are lactose-free. You could also take lactase supplements to help your body process lactose.

Of note, even if you’re not lactose intolerant, the high fat content in cheese may cause discomfort, as it slows down your stomach and leaves food sitting in there for longer than usual.

Maybe the pepperoni?

Your liver produces a greenish fluid called bile, which helps your guts process fat. Extra bile is stored in a nearby little pouch called the gallbladder. When you eat fatty food like pepperoni, your gallbladder injects a dose of bile into your intestines.

Sometimes, bile can crystallize into small stones, which can block the tube draining the gallbladder to the guts. The result is crampy, right-sided, upper abdominal pain primarily after high-fat meals. If the stone gets dislodged and the pain resolves, the condition is known as biliary colic. (If a stone gets really stuck, you’ll likely develop cholecystitis. In this condition, the gallbladder gets infected and often needs to be removed.)

If your doctor diagnoses biliary colic, the best and only long-term solution is to have your gallbladder removed. (Sorry to break the news.) The surgery, known as a cholecystectomy, is almost always done using minimally invasive technique. You should be home after two or three days, with just a few, very small surgical wounds.

Not the tomato sauce!

Acidic foods (like tomato sauce) – as well as spicy foods, carbonated drinks, caffeine, fatty foods, and chocolate – can worsen gastroesophageal reflux disease, also known as GERD.

Your stomach produces acid to help digest food, as well as kill any bacteria along for the ride.  In GERD, stomach acid ventures up to the esophagus (the tube connecting the stomach to the mouth). Since the esophagus is not accustomed to being bathed in acid, it becomes inflamed and painful. The main symptoms include upper belly pain after eating, which gets worse when you lie down (since gravity is no longer helping keep the acid down), gets better after drinking water (which flushes the acid back down), and may be associated with a bitter taste in your mouth.

Lifestyle changes can help, such as cutting back on the above-mentioned foods and not lying down soon after eating. Eat dinner at least two or three hours before bedtime. If your symptoms continue, ask your doctor about taking medications like Zantac, Prilosec, or Nexium.

Was it food poisoning?

Food poisoning may occur when your meal has become contaminated with bacteria or their toxins. Symptoms include nausea, vomiting, and belly pain starting six to twenty-four hours later. The most common culprits include Salmonella(found in eggs, undercooked chicken, and unpasteurized milk), Vibrio(found in raw shellfish), and Staph(found in foods prepared by hand and not cooked afterward, like deli meats, pastries, and salads). Did the other people who ate a slice of your pizza also have similar symptoms?

The key is to stay hydrated using broths and products like Pedialyte. In addition, you might get some relief from Pepto Bismol (which, of note, also turns your tongue black.) See your doctor if you symptoms haven’t improved after three days, or if you’re feeling really dehydrated and can’t keep anything down.

Could it be something else altogether?

It could just be a coincidence that your symptoms started right after a less-than-healthy meal. If you have severe belly pain that is not going away, however, you could have a life-threatening condition that requires immediate attention, like appendicitis, pancreatitis, or a bowel obstruction. If your pain is severe and sustained, go to the nearest Urgicare center or emergency room.

 Thanks to Dr. Benjamin Lebwohl for reviewing some of this content.

Marc Eisenberg, M.D., F.A.C.C.

Marc Sabin Eisenberg, M.D., F.A.C.C., is an associate professor of medicine at Columbia University Medical Center and an attending cardiologist at NewYork-Presbyterian Hospital.

Christopher Kelly, M.D., M.S.

Christopher Rehbeck Kelly, M.D., M.S., is a cardiology fellow at NewYork-Presbyterian Hospital / Columbia University Medical Center.